Our latest blog features MSc Occupational Therapy student Jo Johnson, who takes us on a typical day in her life whilst on placement on surgical wards and ITU.
Hello, my name is Jo and I am a final year MSc Occupational Therapy student, currently undertaking my final practice placement on surgical wards.
The purpose of occupational therapy is to facilitate the client or patient to engage in the occupations that are meaningful to them. There is an endless range, as this can include everything from going to the toilet, brushing your teeth and eating, to things like painting, playing a musical instrument, or mountain climbing.
In a hospital no two days are the same. The surgical wards where I am on placement mostly have patients who have had surgery on their gastric or urinary system, or else have a health complaint related to these areas.
8:00am
I arrive at placement early, and use the first half hour to check my paperwork is up to date, or to look up any unfamiliar terms that I wrote down in my notebook the day before. I am currently getting to grips with a lot of new language!
At 8:30am the team, which is made up of Physiotherapists, Occupational Therapists and Rehabilitation Assistants, heads up to the Intensive Treatment Unit.
It is quite unusual for an occupational therapist to be based on the ITU, but it is an emerging area of practice. Research has shown that helping people who are very unwell or immediately post surgery to complete activities of daily living for themselves aids recovery. It can also help to reduce ITU related delirium.
I accompany my educator to see a patient who had a major surgery the evening before. He is awake, and consents to attempt sitting out of bed and doing some personal care for himself. We have to manage various drains in his body and different lines coming from his arms and neck which are monitoring his vital signs. The patient does really well, managing to get himself into a sitting position on the end of the bed. His blood pressure remains stable so he progresses to standing and then transferring into his chair.
We set him up with a bowl of water, his toiletries and some towels so that he can wash and clean his teeth for himself. We put clean bedclothes on his bed, which is lucky because after he finishes washing his blood pressure starts to drop very low, so we assist him back into bed and document all this in his notes. Once this patient is more stable he will come down to the surgical ward, so he will have the same therapists throughout his time in hospital.
9:30am
We head down to the wards and get a handover from the nurses about the different patients. Some of them we know already and others are new. I do a couple of initial interviews with patients. These interviews are to gather information about how they manage with their various occupations at home, such as personal care, domestic tasks and their hobbies. This can help to find out if a patient needs further rehabilitation or extra support at home, so we can plan our interventions or make the appropriate referrals onto rehab placements or to social services for a package of care to be put in place.
I file these interviews in the patients’ notes, and document this. One of them told me that he normally mobilises with a zimmer frame, but it isn’t here so he can’t get about. I take a zimmer frame over and adjust it to the correct height before assessing his ability to go from a sitting to standing position and walking with the frame. He is independent with both, and so is now able to mobilise safely, get to the loo on his own and spend time away from his bed, which is much better for him! I document this assessment in the patient’s notes.
12:00pm
We don’t see patients over lunchtime, so use the last half hour before our own lunch break to get up to speed on notes and plan for the afternoon. Following lunch the team meets briefly to figure out workloads before heading back to the wards.
1:30pm – 4:30pm
One of the patients on our caseload has been showing signs of confusion on the ward and during our initial interview. The patient was admitted with signs of self-neglect. My educator instructs me to go with one of the rehab assistants to the occupational therapy kitchen and assess the patient making a hot drink for herself.
Observing the patient engaging in an occupation like this gives us the opportunity to assess various motor and process skills. We notice that the patient struggles to remember information and requires a lot of prompting to get started, though once she does start she completes the task without further problems. She also appears confused several times during the conversation to and from the kitchen. We document all of this on the functional assessment pro-forma and in the patient’s notes. My educator makes a plan to do a cognitive assessment with the patient to provide further evidence that she may need support at home when she is discharged.
After meeting a couple more patients for initial interviews and mobility practice and documenting all this in their notes, suddenly the day is over.
5:30pm
Over a much-needed cup of tea at home I write a reflection on the kitchen assessment I participated in earlier and also write in my journal everything I did over the day. These reflections inform learning and help me to figure out how to improve for next time.
What appeals to me most about occupational therapy is that the focus is on making sure people have the opportunities to do the things that are important to them. The underpinning philosophy of occupational therapy is that every person, no matter their background, has a right to engage in occupations that are meaningful to them. The occupational therapist’s role is an analytical one. The chosen activity and the client’s performance is broken down into components so that we can identify the barriers to participation, be they physical, environmental or structural, and to help the patient or client to remove or overcome them.